Why are oesophageal cancer rates going up in men?

Many people have never even heard of cancer of the oesophagus – a form of cancer affecting the pipe that connects the mouth to the top of the stomach.

Yet rates of this cancer are on the rise.

According to new figures we released today, the rise is most rapid in men – among whom a particular form of the disease, called adenocarcinoma, is one of the fastest rising cancers in the UK.

But what’s causing this rise? And – most importantly – what can be done about it?

In this post, we’ll look at what’s going on, and whether our lifestyles might be behind the rise.

And we’ll also meet a heroic team of marathon-running medics who are doing everything they can to change the picture for patients diagnosed with oesophageal cancer – one of the hardest forms of cancer to treat successfully, but one which generally gets little attention in the media.

What is oesophageal cancer?

Every day around 23 people in the UK are diagnosed with oesophageal cancer, about eight out of ten of whom are aged 60 or over, and about two thirds of whom are men.

As with many types of cancer, things in our ‘modern’ lifestyles can affect the risk – the disease is more common among people who smoke, drink heavily, are overweight or obese, or who eat a diet low in fruit and veg. And people with long-term persistent heartburn – something that can also be linked to obesity – have a higher risk too.

In general, survival rates for cancer of the oesophagus are low compared with other cancers – partly because the disease is often diagnosed at a late stage.

Overall, for every 100 people diagnosed with the disease, only around 13 are alive five years later. But when the disease is diagnosed in its earliest stage, this figure rises to about 80 out of 100. Sadly, only a small proportion of patients are diagnosed this early.

Treatment for early-stage disease usually involves a course of chemotherapy to shrink the tumour, followed by surgery, and aims to cure it. For later stage disease, treatment is aimed at controlling the disease and alleviating symptoms.

Different types, different causes?

There are two main types of cancer that affect the oesophagus, called squamous cell carcinomas and adenocarcinomas, and the evidence suggests they have different triggers.

Squamous cell carcinomas seem to be linked to smoking and drinking. Rates have remained roughly constant in men and women since the mid 90s.

Adenocarcinoma – the form that’s on the increase – is also linked to smoking, but less strongly than squamous cell carcinomas. But it also seems to be linked to long-term acid reflux (heartburn), which itself is more likely if you’re overweight or obese.

There are a few theories about how heartburn can lead to cancer. The main one is that having long-term, persistent heartburn causes chronic inflammation in the cells lining the oesophagus. As well as causing them to divide more rapidly – this inflammation also seems to cause tell-tale chemical changes to the DNA inside them.

These changes, researchers think, lead to a condition called Barrett’s Oesophagus, which – in a small minority of people – can go on to develop into cancer.

People diagnosed with Barrett’s Oesophagus are offered regular screening with an endoscope (a camera that goes down your throat) to spot early signs of cancer.

Increasing rates

As you can see from the graph below, rates of oesophageal cancer in men have risen by almost 60 per cent over the last 30 years, and by 10 per cent in women – but why?

When we looked at the breakdown of what was causing the increase, we found something surprising: it was almost entirely down to rising rates of adenocarcinoma in men.

Oesophageal cancer is on the rise

Why would this be?

One culprit could be increasing rates of heartburn. According to a recent Norwegian study, discussed here on NHS Choices, “the number of people experiencing at least one acid reflux attack a week has risen from 11.6 per cent to 17.1 per cent in just over a decade, while those suffering severe symptoms is up from 5.4 per cent to 6.7 per cent”.

Only a small proportion of people with heartburn will go on to get oesophageal cancer, but if this rise in Norway reflects the UK situation, it’s worrying nevertheless.

Oesophageal cancer is more common in people who are overweight or obese

However, intuitive as it may sound, researchers don’t yet know for definite whether heartburn caused by rising obesity is leading to more oesophageal cancer – it wouldn’t explain the differences in rates between men and women (as the rate of increase in obesity has been approximately equal in men and women).

So why the increase in adenocarcinoma in men? We can’t be sure, and there’s a lot more work to be done here too. However, we have some theories.

One idea is that women’s hormones might play a role in protecting them against the disease, and there’s some evidence for this.

Another idea might be that the type of obesity that’s more common in men, called abdominal obesity, might be linked to increased rates of oesophageal cancer (it does increase the risk of certain other cancers). However, there’s no evidence yet to show whether this type of obesity is especially linked to oesophageal cancer, so at this stage this remains just an idea.

Early diagnosis is important

Whatever the reason, we know that early diagnosis makes a difference. Which brings us to two more issues:

Firstly, over-the-counter heartburn medicines – Rennies, Zantac and the like. These are readily available, so people with long-term heartburn sometimes try to control things by popping a pill every now and again – rather than seeing a doctor.

Secondly, we know that people don’t always know a huge amount about cancer symptoms (and men less so than women) – which in the case of oesophageal cancer are difficulty swallowing food, or food feeling like it’s got stuck in your throat, as well as long-term heartburn. So people may not seek help from a GP for something that could be a sign of a serious problem.

In short – don’t ignore any changes to your body that aren’t normal for you – either long-term heartburn or food getting stuck in your throat.

Do go and see your GP, and get checked out. It’s unlikely to be cancer, or lead to cancer, but it’s always better to be safe.

What can be done?

Research is the key to progress against cancer, and there are three key areas where research can make a difference:

We need to understand more about what raises the risk of oesophageal cancer and how we can help people live healthy lives to reduce the risk.

We need to improve the way we (as a society) diagnose oesophageal cancer, so that people with the disease get to a specialist earlier.

We need to find better ways to treat the disease, especially at a late stage.

At Cancer Research UK we’re funding research in all these areas. For example, we’re funding a very promising trial led by researchers in Cambridge, looking at whether collecting cells from the oesophagus using a device called a cytosponge can spot early signs of the disease.

And one of the most exciting projects we’re involved with is our work as part of the International Cancer Genome Consortium (ICGC) – an international project to map all the genes involved in several different types of cancer, to look for clues for new treatments and better understanding. Our scientists are bringing their gene-hunting expertise to bear on oesophageal cancer, and we’re expecting their first round of results to emerge later this year.

Running for progress

But we want to leave you with the exciting and inspirational story of a team of medics from Southampton, who want to make a difference for people affected by this terrible disease.

They’re currently training to run the New York Marathon in November, both to raise awareness of oesophageal cancer, and to raise money to fund our ICGC genetics project.

We’ll be following their progress over the coming months, but here’s the first instalment of their story – The Cancer Marathon – which also follows their patients as they go through treatment for oesophageal cancer.

This is something surgeon Tim Underwood (one of the runners) often describes as “like running a marathon without any training”.

And if you want to support their marathon effort, you can do so over at JustGiving, where their page is www.justgiving.com/thecancermarathon. They’re trying to raise £100k, so every donation will count, no matter how small.

I had flu over Christmas 12 years ago and at the time was being seen by a specialist for enlarged prostate, I had an appointment with him early in January and he asked about my general health, I said I had had the flu but was having difficulty in swallowing afterwards, he sent me straight away to another consultant who referred me to St. Thomas’s in London to the oncology department, where I met Mr. R Mason. He immediately booked me in for the removal of the oesophagous, but also sent me for scans, tests etc. to see how far it had spread, fortunately it hadn’t so they went ahead with the operation and I’m still around eleven years later. St. Thomas’s saw me every six months to check on progress, however after five years they said I had beaten the cancer and didn’t need to return for further check ups.
Because I had been diagnosed early on I am able to fulfill a normal life, although I can’t eat as much as I used to, all thanks to Mr. Mason.

Teresa.
Reading peoples comments on here I do realize how lucky I was. I moved to a different part of the country a few years ago and when registering with the new GP practice and discussing my history, the nurse couldn’t believe I was referred for investigation without trying me with some kind of medicine first.

At the time I had asked the Dr why he acted so quickly, he said when someone of my age suddenly develops indigestion then it deserves thorough investigation.

One point I should have made in my previous comment was that in my Dad’s life then he had virtually no chance of survival and in fact lasted about 2 weeks after diagnosis. With myself and advances in technology, i.e. endoscopic investigations brought earlier diagnosis but still I had to have THAT operation. Hopefully the next generation should benefit from the new method they are working with where one swallows a sponge which is then analyzed for pre-cancerous cells and then a much less invasive treatment used.

I so agree with Carol, what I did not say above was my Wonderful husband had indigestion & suffered terrible reflux popped rennies like sweets since a very early age, always was mentioned if he went to the Doctors – If he was screened earlier would he have been saved I don’t know but others should be given the chance. So let’s do something about this let the public know through the media & papers it might save someones life. Ray what a wonderful Doctor you had you are still with us which just goes to prove screening will save lives..

I agree with Carol, it’s about time these cancer facts are spread to the majority. Until I was diagnosed with this disease, I had never heard of Oesophageal cancer. Why doesn’t the government and Cancer Research. spend some of the vast amounts of money they have, and spend it on notifying the public on what to look out for. It’s a disease with a poor survival rate because by the time the individual goes to his doctor for help, it is usually to late. I know as I’m one of those people.

I totally agree its a disgrace that a screening program has not been set up already. The government needs to rethink these program’s. lives can be saved and extended. My fathers last few months were utter misery . I work in the nhs I see quite clearly money being wasted. eg. Chlamydia screening program where this disease is easy treated by antibiotics.

I couldn’t agree more with the comments made regarding acid reflux. My lovely mum died of this disease and it was certainly the acid reflux that caused her cancer. It is clear to me now that she should have received regular screening for cancer because of this but, of course, this was never offered to her or mentioned by her GP.

My father died of this dreadful disease in 2010, he had heartburn and a stomach ulcer. He had trouble swallowing but we found out to late, as he didn’t confide in anyone. His cancer was untreatable and after having a stent fitted which really didn’t help him. He passed away 7 weeks after his diagnosis He had been to the doctors several times and was told not to worry his heartburn would pass with medication. I am so grateful to CR for all the work you are doing to help find a cure to this disease which took my beloved father from me.

Based on my own experience my first conclusion is earlier and better diagnosis is vital. My prime symptom was severe hiccups after managing to swallow food without apparent difficulty – but although I’ve publicised this comment before it’s still only ‘swallowing difficulty’ that’s flagged up. And GP’s need to improve their capability in spotting the early signs of OC. I was misdiagnosed in my practice so was referred too late for a gastroscopy which showed up the tumour.
My local hospital failed me too because after a laparoscopy by a generalist surgeon I was declared inoperable and offered palliative chemotherapy. I decided to take the initiative and through the internet discovered the Oesophageal Patients Association (OPA). They put me in touch with a wonderful surgeon in Heartlands Hospital Birmingham who decided he could be operate after a bout of aggressive chemotherapy which he arranged in Wolverhampton. I was living in Northampton but all of this was done on the NHS. So my second conclusion is to agree with recent studies recommending the NHS concentrates specialist treatments in fewer larger hospitals where best practice expertise and equipment can be made available 24/7.
I was first diagnosed in June 2004, seen by Birmingham surgeon in August and after chemo operated on by him in November before more chemo finishing in March 2005. I am pleased to add that aside from some minor discomforts (like having to sleep propped up on a special pillow) I’m still enjoying life to the full in 2013 having just reached 70.

My beloved husband died of this terrible disease in 2004, he was diagnosed in april and he died in June. It was a neglect from the doctors who treated him for heartburn and told him to drink gaviscone, how much are you supposed to drink before they acknowledge a problem….. He too had a stent fitted just so he could eat something and make his last days more comfortable, but that was short lived as he could not even cope with his own saliva….. I think it is brilliant what CR does for all of us, let’s hope the GPs think more about the patients health rather than how much money they can save the practise…

My husband had cancer of the oesophagus and he didn’t smoke and rarely drank. He had to have a stent fitted because he could couldn’t even keep water down. After all the treatment they told him the tumour had shrunk. But then 5 weeks later he became breathless, the doctor said the treatment had left him breathless. But two days later he died suddenly and the post mortem revealed he had an undetected heart disease. Life is so cruel he was ill for less than a year. His brother has also had oesophageal cancer but now 5 years later he has been given the all clear.

I also had oesophageal cancer at 57, the same age as my Dad died of cancer. I was very fit, slim and vegetarian. I didn’t smoke and drink. I developed intermittent indigestion in late summer of 2001. I mentioned it to the doctor when I was visiting for another reason a couple of months later. He immediately referred me to the consultant for investigation. The cancer was confirmed at Christmas that year. I had the operation (cardio oesophagectomy) early January. Unfortunately there was a leak which meant a repeat operation.
Now 11 years on I have an active life, dancing 2 or 3 times a week, walking and some cycling,bowling in the summer and lots of traveling. A couple of round the world trips and regular shorter holidays.
Life is more restricting but at 68 I feel I can do most things I want to do.

Our brother died 1 year ago, aged 61, from oesophageal cancer.He was diagnosed in February 2012 and passed away on 12th July. He never smoked,didn’t drink, looked after his health and had been slim all of his life. However he did suffer from heartburn. Surely with all the media campaigning for lung and breast cancer,there should be a campaign to warn people who have persistant heartburn, about the dangers of this terrible cancer and encourage them to see their GP immediatley so they be offered regular screening before it’s too late.

My father died of this terrible cancer in 2009. He had suffered all his life with acid reflux due to a hiatus hernia. Why aren’t people with such risk factors being offered regular screening. He was a very healthy man this disease ravaged his body in just 10 months. He did nt deserve to die like that.

I agree with the comments made earlier. My lovely Brother-in-law died of this dreadful disease 2 years ago aged 58 he wasn’t overweight, never smoked, very fit and drank very little. He had chemotherapy then surgery and never came home. I was diagnosed with Barretts Oesophagus 10 years ago and get regular checks very interested in the research being done with the cytosponge. Good luck to all in the cancer marathon

My wonderful husband died in January of oesphageal cancer. He didn’t smoke or drink and he wasn’t overweight. He was 6’2 and 52years old. He worked as a Practice Manager with doctors. I’m a nurse and I’ve worked with Health Promotion. If anyone should have found it earlier we should, we didn’t. He had no symptoms before the end of November. He was diagnosed just after Christmas and died 4 weeks later. I have three children, 12, 19 and 22. We all miss him and I can’t really believe it could happen to him. My two daughters and me did the race for life on Sunday, I agree with Caroline that more needs to be done to understand the causes of this cancer. I can’t believe it is just due to lifestyle. We had a good active healthy lifestyle, we had plans.

My brother-in-law died 3yrs ago of oesophageal cancer at the age of 48. He was slim, fit, didn’t smoke or drink. He was diagnosed 2wks before he died. The cancer had spread to his liver, pancreas and colon. He was not unwell before he travelled to the US to celebrate 25years with my sister but was admitted to hospital with breathing problems. He was flown back to the UK, admitted to Addenbrookes Hospital in Cambridge…..and never returnd home. This was a horrible time, especially for Cheryl, my sister, and their 2 daughters, Sophie 14, and Phoebe 12. Why is this disease associated with obesity, smoking and drinking? More needs to be done to understand the causes of this cancer.

I lost my lovely son at the age of 40 to this dreadful form of cancer; he underwent the surgery, which is itself terrible, but it didn’t save him. He never smoked, was never overweight, never drank to excess and was extremely fit; cycling, white water rafting, competing in triathlons and scuba diving. He suffered from acid reflux and his doctor prescribed for this; if only she had sent him for a second opinion earlier.

I am being monitored for this pre-cancerous condition but never smoked, consumed little alcohol, and was as thin as a pole. My symptoms are due to having ulcers and acid reflux since I was 12 (I am now 56) and not helped by a hernia at the gullet. So just being overweight is not a trigger; acid reflux seems to be a major contributor…

My father was suspected of having this form of cancer, and to be honest I had not heard about it until that point. Luckily he was given the all clear, although he was a smoker (he has now quit). I assumed it was very rare but from this article I can see that it is something that needs to be publicised.

As a sufferer of this form of cancer I would like to see some television information put out there. As this is the fastest growing cancer, people should know as much as possible about the disease publicised. I’m sure it would help future sufferers…..

Why is cancer always associated to smoking & drinking not in all cases, my wonderful husband died of the above cancer & he was as fit as a fiddle never ill a day in his life until this & then that was the end more has to be said on this type of cancer as all are potential killers, but this one is a killer. After his operation he never stood a chance so yes more has to be done on above.

As a survivor of this cancer, three years plus, and counting. I have found these articles encouraging to say the least. Up until now I have found only the most basic information on the internet. This article and the many other artlcles have been very informative. I have been active in one of the trials with the hope it will help future sufferers.

Follow us

Cancer Research UK is a registered charity in England and Wales (1089464), Scotland (SC041666) and the Isle of Man (1103). A company limited by guarantee. Registered company in England and Wales (4325234) and the Isle of Man (5713F). Registered address: Angel Building, 407 St John Street, London EC1V 4AD.